Provider Demographics
NPI:1982010443
Name:THORNHILL, PETER (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:THORNHILL
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3901
Mailing Address - Country:US
Mailing Address - Phone:707-524-4690
Mailing Address - Fax:
Practice Address - Street 1:719 SPRING ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3901
Practice Address - Country:US
Practice Address - Phone:707-524-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-05
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA149703207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program